S Salari1, A R Khosravi2, S A A Mousavi3, G H Nikbakht-Brojeni4. 1. Department of Medical Parasitology and Mycology, Kerman University of Medical Sciences, Kerman, Iran; Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Kerman University of Medical Sciences, Kerman, Iran. Electronic address: sa_salari@kmu.ac.ir. 2. Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran. 3. Department of Medical Parasitology and Mycology, Kerman University of Medical Sciences, Kerman, Iran. 4. Department of Microbiology and Immunology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
Abstract
OBJECTIVES: The opportunistic pathogen Candida albicans is the major agent of oropharyngeal candidiasis (OPC) in HIV/AIDS patients. The increased use of fluconazole can lead to the emergence of azole-resistant strains and treatment failures in PLWH (people living with HIV) receiving long-term therapy for OPC. The purpose of this study was to evaluate CDR1, CDR2, MDR1, and ERG11 gene expression in C. albicans clinically isolated from HIV-infected patients in Iran. PATIENTS AND METHODS: In this study, we evaluated the molecular mechanisms of azole resistance in 20 fluconazole-resistant C. albicans isolates obtained from Iranian HIV-infected patients with oropharyngeal candidiasis by Real-Time polymerase chain reaction. RESULTS: The overexpression of drug efflux pump CDR1 gene was found to be the major resistance mechanism observed in these isolates. The overexpression of the CDR1 gene correlated strongly with increasing resistance to fluconazole (P<0.05). Additionally, an increased level of mRNA in ERG11 was not observed in any of the tested isolates. CONCLUSIONS: Our findings suggested that the CDR1 gene expression to fluconazole resistance in C. albicans is greater than other known genes.
OBJECTIVES: The opportunistic pathogen Candida albicans is the major agent of oropharyngeal candidiasis (OPC) in HIV/AIDSpatients. The increased use of fluconazole can lead to the emergence of azole-resistant strains and treatment failures in PLWH (people living with HIV) receiving long-term therapy for OPC. The purpose of this study was to evaluate CDR1, CDR2, MDR1, and ERG11 gene expression in C. albicans clinically isolated from HIV-infectedpatients in Iran. PATIENTS AND METHODS: In this study, we evaluated the molecular mechanisms of azole resistance in 20 fluconazole-resistant C. albicans isolates obtained from Iranian HIV-infectedpatients with oropharyngeal candidiasis by Real-Time polymerase chain reaction. RESULTS: The overexpression of drug efflux pump CDR1 gene was found to be the major resistance mechanism observed in these isolates. The overexpression of the CDR1 gene correlated strongly with increasing resistance to fluconazole (P<0.05). Additionally, an increased level of mRNA in ERG11 was not observed in any of the tested isolates. CONCLUSIONS: Our findings suggested that the CDR1 gene expression to fluconazole resistance in C. albicans is greater than other known genes.